Just need to spend a few moments describing a paper I just read: An Evolutionary Stress-Response Hypothesis for Chronic Widespread Pain (Fibromyalgia Syndrome) by Lyon, Cohen and Quintner. In it the authors posit that fibromyalgia is best conceptualized as a collection of syndromes related to chronic activation of the body's stress-response system, with specific focus on the neuropeptide substance P (a little disappointed there's not more about cortisol or noradrenaline here, but the argument still holds). This is a narrative review through and through, so not meant to be a critical review of the papers cited as evidence (thus requiring a measure of caution in interpreting the author's positions). However, this is a well-written piece with a nicely structured argument, that highlights the folly of searching for a single 'silver bullet' pharmaceutical approach to treatment FM. In fact, one passage is so relevant for Physios and other Allied Health Professionals that I need to share it, with full credit to the authors here. For the sake of clarity, the SP/NK1R pathway refers to Substance P and its preferred receptor, the neurokinin-1 receptor.:
Couldn't have said it better myself. In fact, one is now left to wonder if it's time for a change in the very label 'fibromyalgia'. When taken literally, FM implicates some kind of fibrous tissue or muscle as the primary symptom drivers of pain. Surely this has lead to several ineffective attempts at treatment for FM by targeting these tissues. Should the name be something more like 'Disordered Stress Syndrome' or 'Stress Dysfunction Syndrome'? Or does it even need a label? The argument regarding the usefulness of medical labels is best reserved for a future discussion. Any thoughts?